Transcript ICN - Advancing nursing and health worldwide

Introduction to the International
Classification for Nursing Practice
(ICNP®)
Nick Hardiker, RN PhD
Director
ICN eHealth Programme
ICN - Advancing nursing and health worldwide
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• ‘Technological progress is like an axe in the
hands of a pathological criminal’
Albert Einstein
ICN - Advancing nursing and health worldwide
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ICN - Advancing nursing and health worldwide
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• ‘Gravitation is not responsible for people falling
in love’
Albert Einstein
ICN - Advancing nursing and health worldwide
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• ‘Imagination is more important than knowledge’
Albert Einstein
ICN - Advancing nursing and health worldwide
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The International Council of Nurses
• A federation of more than130 national nurses
associations representing more than 16 million
nurses worldwide
• Operated by nurses and leading nursing
internationally since 1899
• Its purpose is to represent nursing worldwide,
advancing the profession and influencing health
policy
ICN - Advancing nursing and health worldwide
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ICN - Advancing nursing and health worldwide
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ICN - Advancing nursing and health worldwide
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Hospital statistics
• ‘In attempting to arrive at the truth, I have
applied everywhere for information, but in
scarcely an instance have I been able to obtain
hospital records fit for any purposes of
comparison’ (p 176)
Nightingale F. Notes on Hospitals. 3rd Edition. London: Longman, Green,
Longman, Roberts, and Green, 1863
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ICN eHealth Programme
• Transforming nursing through the visionary
application of information and communication
technology
• 25 years in the making
• Announced at the ICN Conference 2011 in Malta
http://www.icn.ch/pillarsprograms/ehealth/
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A personal vision
• eHealth systems are in routine use to parallel
other aspects of contemporary life
• Data is available and routinely used/exploited for
the benefit of patients and those caring for them
• People are actively working on continually
improving how things are i.e. advancing together
the art/science of nursing informatics
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eHealth
ICN - Advancing nursing and health worldwide
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Emerging position statement
• The right to connect via information and
communications technology
– ICT can improve access to good healthcare, address
inequalities in its provision and help citizens take a
more active role
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Why ICN eHealth?
• Worldwide proliferation of ICT
• ICN informs, supports and advocates for nursing
and its members
• eHealth threads through ICN processes and
products
• ICT in health care provides new opportunities,
not least equity and improved access
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ICN eHealth workstreams
• Connecting Nurses
• ICN Telenursing Network
• International Classification for Nursing Practice
(ICNP®)
ICN - Advancing nursing and health worldwide
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Connecting nurses
• A forum for expert healthcare professionals from
around the world to share their ideas, advice
and innovations
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Information Shareapy
• A patient education service for nurses and
midwives to share, via a dedicated and
moderated social network, links to high quality,
reputable health resources with their patients,
families, friends or colleagues
ICN - Advancing nursing and health worldwide
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ICN - Advancing nursing and health worldwide
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Care Challenge
• A contest that highlights nursing innovations and helps to
put them into practice
• There have been two winning entries this year. The
authors have chosen a professionally produced video
displaying their project as means of support from
Connecting Nurses
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ICN - Advancing nursing and health worldwide
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ICN Telenursing Network
• Global resource for sharing knowledge and
expertise around telehealth and telecare
• Launched in 2009
• 296 members in 65 countries
• Membership open to all
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ICNP
• ICN has supported ICNP since 1989
• A standardised terminology used to represent
nursing diagnoses, interventions and outcomes
http://www.icn.ch/pillarsprograms/international-classification-fornursing-practice-icnpr/
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ICNP Characteristics
• Reliable
• Compliance with international standards
• Quality improvement process
• A formal infrastructure that facilitates cross-mapping
and allows output in multiple formats
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ICNP Characteristics
• Easy to understand
• Ongoing focus on pre-formed (pre-coordinated)
statements
• Increasing numbers of catalogues (subsets tailored
for specific purposes)
• Available in 15 different languages
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ICNP Characteristics
• Internationally-recognised
• Recognised by a number of National Nurses
Associations
• A Related Classification in WHO-FIC
• Harmonisation/collaboration agreements with other
standards development organisations
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Vital statistics
• 783 pre-coordinated diagnosis and outcome
statements (15% increase from 2011)
• 809 pre-coordinated intervention statements
(50% increase from 2011)
• The 2015 release will comprise over 4000
elementary and pre-coordinated concepts
ICN - Advancing nursing and health worldwide
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ICN - Advancing nursing and health worldwide
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ICN - Advancing nursing and health worldwide
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ICNP® Application & Development
• Practical use at point of care
– A degree of national endorsement in Portugal,
Norway, Canada, USA
– Commercial agreements with software suppliers in
Norway, USA, Portugal
• Catalogue development and translation activity
• Individual and collaborative R&D projects
• ICN Accredited Centres for ICNP® Research &
Development
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ICN Accredited Centres for ICNP®
Research & Development
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Australia – Canberra
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Australia – Flinders
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ICNP® and disaster nursing
Brazil
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ICNP® and evidence-based practice
Development and use of ICNP®
Canada
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ICNP® and RNAO Best practice guidelines
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Chile
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German-speaking countries
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Iran
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3 NNAs and 3 national user groups – Translation - Development and use of ICNP®
Translation - Development and use of ICNP®
Korea
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ICNP® and family nursing
Translation - Development and use of ICNP®
Poland
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Translation - Development and use of ICNP®
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Portugal
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USA
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Improve quality of care through Nursing Information Systems and ICNP®
ICNP® and minimum data sets
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Natural language (speech and text)
• Main currency for clinical information
• Expressive
• Familiar...
...but complex and difficult to analyse, manipulate
and reuse
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Finding the incidence of heart disease
 angina pectoris
 mitral stenosis
X angina pectoris ruled out
X family history of heart disease
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Proliferation of terminologies
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Many tasks, many users
Health care changes constantly
Health care is very ‘big’
For a particular purpose it is easy to build your
own
• Terminologies are getting bigger, more
numerous, more complex
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Terminologies within UMLS
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AI/RHEUM, 1993
Alternative Billing Concepts
Alcohol and Other Drug Thesaurus, 2000
Beth Israel Vocabulary, 1.0
Canonical Clinical Problem Statement System,
1999
• Clinical Classifications Software, 2003
• Current Dental Terminology (CDT), 4
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COSTAR, 1989-1995
Medical Entities Dictionary, 2003
Physicians' Current Procedural Terminology, 2004
Physicians' Current Procedural Terminology, Spanish Translation,
2001
CRISP Thesaurus, 2004
COSTART, 1995
Diseases Database, 2000
German translation of ICD10, 1995
German translation of UMDNS, 1996
DSM-III-R, 1987
DSM-IV, 1994
DXplain, 1994
Gene Ontology, 2004_03_02
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HCPCS Version of Current Dental Terminology (CDT), 4
HCFA Common Procedure Coding System, 2004
HCPCS Version of Current Procedural Terminology (CPT), 2004
Health Devices Alerts, 1999
Home Health Care Classification, 2003
Health Level Seven Vocabulary, 1998-2002
ICPC2E-ICD10 relationships from Dr. Henk Lamberts, 1998
Health Product Comparison System, 1999
ICD10, 1998
ICD10, American English Equivalents, 1998
International Statistical Classification of Diseases and Related Health Problems, 10th Revision,
Australian Modification, January 2000 Release
International Statistical Classification of Diseases and Related Health Problems, Australian
Modification, Americanized English Equivalents, 2000
ICD10, Dutch Translation, 200403
ICD-9-CM, 2004
International Classification of Primary Care, 1993
International Classification of Primary Care 2nd Edition, Electronic, 2E, Dutch Translation, 200203
International Classification of Primary Care 2nd Edition, Electronic, 2E, 200203
International Classification of Primary Care, Version 2-Plus, 2000
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ICPC, Basque Translation, 1993
ICPC, Danish Translation, 1993
ICPC, Dutch Translation, 1993
ICPC, Finnish Translation, 1993
ICPC, French Translation, 1993
ICPC, German Translation, 1993
ICPC, Hebrew Translation, 1993
ICPC, Hungarian Translation, 1993
ICPC, Italian Translation, 1993
ICPC, Norwegian Translation, 1993
International Classification of Primary Care, Version 2-Plus, Americanized English Equivalents, 2000
ICPC, Portuguese Translation, 1993
ICPC, Spanish Translation, 1993
ICPC, Swedish Translation, 1993
Online Congenital Multiple Anomaly/Mental Retardation Syndromes, 1999
Library of Congress Subject Headings, 1990
LOINC 2.12
MEDLINE (1994-1998)
McMaster University Epidemiology Terms, 1992
Master Drug Data Base, 2003_03
Medical Dictionary for Regulatory Activities Terminology (MedDRA), 7.0
Medical Dictionary for Regulatory Activities Terminology (MedDRA), American English Equivalents, 7.0
Medical Dictionary for Regulatory Activities Terminology (MedDRA), Dutch Edition, 7.0
Medical Dictionary for Regulatory Activities Terminology (MedDRA), American English Equivalents with expanded abbreviations, 7.0
Medical Dictionary for Regulatory Activities Terminology (MedDRA), with expanded abbreviations, 7.0
Medical Dictionary for Regulatory Activities Terminology (MedDRA), French Edition, 7.0
Medical Dictionary for Regulatory Activities Terminology (MedDRA), German Edition, 7.0
Medical Dictionary for Regulatory Activities Terminology (MedDRA), Portuguese Edition, 7.0
Medical Dictionary for Regulatory Activities Terminology (MedDRA), Spanish Edition, 7.0
MEDLINE (1999-2004)
Online Mendelian Inheritance in Man, 1993
Multum MediSource Lexicon, 2004_03
Micromedex DRUGDEX, 2001-08
Medical Subject Headings, MSH2004_2003_12_12
Czech translation of the Medical Subject Headings, 2004
Nederlandse vertaling van Mesh (Dutch translation of MeSH), 2004
Finnish translations of the Medical Subject Headings, 2004
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Thesaurus Biomedical Francais/Anglais [French translation of MeSH, 2004
German translation of Medical Subject Headings, 2004
Italian translation of Medical Subject Headings, 2004, 2004
Japanese translations of the Medical Subject Headings, 2004
Descritores em Ciencias da Saude (Portuguese translation of the Medical Subject Headings), 2004
Russian Translation of MeSH, 2004
Descritores en Ciencias de la Salud (Spanish translation of the Medical Subject Headings), 2004
Swedish translations of the Medical Subject Headings, 2004
UMLS Metathesaurus
Metathesaurus CPT Hierarchical Terms, 2004
Metathesaurus FDA National Drug Code Directory, 2004_01
Metathesaurus HCPCS Hierarchical Terms, 2004
Metathesaurus additional entry terms for ICD-9-CM, 2004
International Classification of Primary Care 2nd Edition, Electronic, 2E, American English Equivalents, 200203
Metathesaurus Form of Medical Dictionary for Regulatory Activities Terminology (MedDRA), Spanish Edition, 7.0
Metathesaurus Version of Minimal Standard Terminology Digestive Endoscopy, 2001
Metathesaurus Version of Minimal Standard Terminology Digestive Endoscopy, French Translation, 2001
Metathesaurus Version of Minimal Standard Terminology Digestive Endoscopy, Italian Translation, 2001
Metathesaurus Forms of Physician Data Query Terms 2004
Metathesaurus forms of SNOMED Clinical Terms, 2004_01_31
Metathesaurus forms of Spanish SNOMED Clinical Terms, 2003_10_31
NANDA nursing diagnoses: definitions & classification, 2004
NCBI Taxonomy, 2003
NCI Thesaurus, 2004
NCI SEER ICD Neoplasm Code Mappings, 1999
National Drug Data File Plus Source Vocabulary, March 2004, 2004_03_11
National Drug File - Reference Terminology, 2004_01
Neuronames Brain Hierarchy, 1999
Nursing Interventions Classification, 1999
National Library of Medicine Medline Data
Nursing Outcomes Classification, 1997
OMIM, Online Mendelian Inheritance in Man, 1997
Omaha System, 1994
Patient Care Data Set, 1997
Physician Data Query, 2004
Pharmacy Practice Activity Classification, 1998
Thesaurus of Psychological Index Terms, 2001
Quick Medical Reference (QMR), 1996
QMR clinically related terms from Randolph A. Miller, 1999
Clinical Terms Version 3 (CTV3) (Read Codes), 1999
Read thesaurus, American English Equivalents, 1999
Read thesaurus Americanized Synthesized Terms, 1999
Read thesaurus, Synthesized Terms, 1999
RXNORM Project, META2004AB
SNOMED Clinical Terms, Spanish Language Edition, 2003_10_31
SNOMED-2, 2
SNOMED International, 1998
SNOMED Clinical Terms, 2004_01_31
Standard Product Nomenclature, 2003
Metathesaurus Source Terminology Names
UltraSTAR, 1993
UMDNS: product category thesaurus, 2004
University of Washington Digital Anatomist, 1.7.3
Veterans Health Administration National Drug File, 03
WHO Adverse Reaction Terminology, 1997
WHOART, French Translation, 1997
WHOART, German Translation, 1997
WHOART, Portuguese Translation, 1997
WHOART, Spanish Translation, 1997
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Multiple nursing terminologies
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Diverse overlapping systems
Endotracheal extubation
Positioning endotracheal tube
Removing endotracheal tube
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A solution?
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Another solution?
Endotracheal extubation
Positioning endotracheal tube
Removing endotracheal tube
ICN - Advancing nursing and health worldwide
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ICN - Advancing nursing and health worldwide
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ICN - Advancing nursing and health worldwide
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ICN - Advancing nursing and health worldwide
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Reference terminologies
• Terminologies with reference properties
– SNOMED® Clinical Terms (SNOMED® CT)
– The International Classification for Nursing Practice
(ICNP®)
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Pain
Acute
pain
Acute pain
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Pain that
comes on
suddenly
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Pain
Neuralgia
Acute
pain
Acute pain
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A unifying framework in practice
• As a unifying framework ICNP® should be able
to:
– handle a range of nursing terminologies
– determine any relationships/mappings between them
• the same entities
Equivalence
– ‘Acute pain’
» is equivalent to
– ‘Pain that came on suddenly’
• entities with more/less detail
– ‘Acute pain’
» is a child of
– ‘Pain’
Subsumption
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How many
times do we
do bladder
washouts?
Bladder washout
ICNP
IrrigatingBladder
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How many
times do we
do bladder
irrigations?
Bladder irrigation
ICNP
IrrigatingBladder
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How many
bladder
procedures
do they do?
Bladder procedure
ICNP
PerformingOnBladder
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Bladder washout
Action
Performing
Irrigating
Bladder irrigation
IrrigatingBladder
PerformingOnBladder
BodyPart
UrinaryBladder
Bladder procedure
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Action
Performing
Irrigating
IrrigatingBladder
Before
PerformingOnBladder
BodyPart
UrinaryBladder
Action
Performing
Irrigating
IrrigatingBladder
After
PerformingOnBladder
IrrigatingBladder
BodyPart
UrinaryBladder
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How?
• The primitive Irrigating is a child of Performing
• Both ‘act on’ Urinary Bladder
• We overlooked the fact that IrrigatingBladder
SHOULD BE a child of PerformingOnBladder
• Software can use the semantic information we
provide to help manage the terminology
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Action
Performing
Irrigating
IrrigatingBladder
PerformingOnBladder
IrrigatingBladder
BodyPart
UrinaryBladder
Bladder procedure
Bladder irrigation
Bladder irrigation = Bladder washout
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Pain
Gall stone
Acute pain
Cholelithiasis
Dog
Cat
Mammal
Dog
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Primary use of clinical data
• Facilitating communication
• Providing a record of care
• Acting as an aide memoire
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Focus for ICNP®
• Using ICNP® to provide raw data for primary use
– Catalogues
– Clinical Care Classification
– SNOMED® CT
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Secondary use of clinical data
Region
Hospital
Abstraction
Aggregation
Country
Unit
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Examples of secondary use
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Mortality and morbidity reporting
Public health surveillance
Clinical audit
Research
Hospital financing
ICN - Advancing nursing and health worldwide
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Focus for ICNP®
• Using the International Classification for Nursing Practice
(ICNP®) to provide raw data for secondary use
– Hierarchisation
– Belgian Nursing Minimum Data Set (B-NMDS)
– International Classification of Health Interventions
(ICHI)
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International
Council of Nurses
ICNP® 25th Anniversary
1989-2014
Next steps for ICNP®
• Reassert ICNP as a key component of the global
informatics infrastructure
• Routine biennial release (with early release for
commercial partners and translators)
• Implementation
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Facilitate translation
Continue development and publication of catalogues
Complete mapping to SNOMED® CT and other terminologies
Foster further commercial partnerships
• Dissemination
– Easier distribution
– Presentations and publications
– Positions, eHealth Bulletin, web pages
ICN - Advancing nursing and health worldwide
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[email protected]
ICN - Advancing nursing and health worldwide
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